Provider Demographics
NPI:1306801089
Name:PAYNE, ERIC MATTHEW (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MATTHEW
Last Name:PAYNE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13601 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7219
Mailing Address - Country:US
Mailing Address - Phone:305-235-1721
Mailing Address - Fax:
Practice Address - Street 1:13601 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7219
Practice Address - Country:US
Practice Address - Phone:305-235-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3822152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU17458Medicaid
FLU17458Medicaid
FL6208533.00Medicare ID - Type Unspecified